Background: To compare the differences in wavefront aberrations between healthy and diabetic children with normal central vision and to investigate the causes of declined visual quality in diabetic children.Methods: This was a case-control study. Children with or without diabetes with normal central vision were selected as case and control group. The wavefront aberration parameters, including spherical aberration, coma aberration, root mean square of total wavefront aberration, root mean square of higher-order wavefront aberration, and corneal curvature, were measured by an automatic multifunctional ophthalmoscope. Statistical analysis was performed to determine the differences in average binocular wavefront aberration between groups. The correlations between wavefront aberration and age, visual acuity, corneal endothelium, intraocular pressure, axial length, corneal diameter, central corneal thickness, crystal thickness, anterior and posterior surface curvatures, and anterior chamber depth were analyzed in the diabetic group.Results: 32 patients with diabetes and 38 age- and sex-matched individuals were enrolled. The mean total and higher-order aberrations in diabetic group were slightly higher than those in control group, with no significant difference between groups (P > .05). The root mean squares of the aberrations correlated with anterior and posterior surface curvatures (P3mm = .014, P5mm = .021; P3mm = .035, P5mm = .038, respectively), but not with age, visual acuity, corneal endothelium, intraocular pressure, axis, corneal diameter, central corneal thickness, crystal thickness, and anterior chamber depth.Conclusions: For diabetic children, subtle changes in lens may lead to changes in wavefront aberrations and this may be the causes of visual impairment. These findings indicate the need to strengthen early screening and close follow-up of wavefront aberrations in diabetic children.Trial registration: This was a case-control study based on a hospital population (NCT 03587948). Date of registration was 07/03/2018. The name of the registration is Shanghai Children and Adolescent Diabetes Eye Study.